Can exercise before surgery help knee replacement recovery?

What can I practice before surgery?

Practice what you’ll do after surgery: rise from a firm chair, walk with an aid, and move through the house safely. A short, level walk can show how far you can go comfortably. Light leg work may help, but don’t turn it into a contest because days of extra soreness won’t help you prepare.

Ask which movements fit your knee and health. Have the surgery team show you how to use a cane or walker when you’re tired. Check which medicines need different instructions before the operation.

Practice while there’s no rush.

What will make the first days at home easier?

Choose a firm chair that’s easy to rise from, then clear the way to the bathroom and remove anything that could catch your foot. Put meals, water, medicines, and a phone within easy reach. Arrange a driver and home help before surgery day.

Recovery takes work, and soreness won’t vanish on a set date. Follow the surgery team’s directions for movement, wound care, and medicine. Call if swelling, redness, or drainage is worse than they told you to expect, and don’t wait for the next visit when something feels plainly wrong.

A ready house saves strain.

Sources

1. A meta-analysis of seven studies (419 patients) of preoperative high-intensity strength training before total knee arthroplasty found statistically significant post-operative improvements versus control in the 6-minute walk test (pooled SMD 0.73, 95% CI 0.04 to 1.41), range-of-motion flexion (0.40, 95% CI 0.08 to 0.72), SF-36 (1.54, 95% CI 0.32 to 2.75) and WOMAC (-0.78, 95% CI -1.22 to -0.34).

   Huang ST, Yang SW. — Preoperative High-Intensity Strength Training and Outcomes After Total Knee Arthroplasty: A Systematic Review and Meta-analysis.. Sports Health, 2026. DOI: 10.1177/19417381251388638.

2. A systematic review and meta-analysis of 120 randomised trials (10,253 participants) covering resistance training across the knee osteoarthritis continuum - 88 trials in early OA, 13 preoperative, 19 after knee replacement - found improvements in mobility, walking capacity and knee extension strength in early OA (SMD 0.46-0.81, moderate-to-high GRADE), in preoperative knee extension strength (SMD 0.47, high GRADE) and in mobility after knee replacement (SMD 0.58). Resistance training improved pain, symptoms, function and quality of life in early OA but showed NO significant effect on those outcomes preoperatively, with no increased risk versus controls at any stage.

   Brown RCC, Mora-Traverso M, Fernández-González M, et al. — Efficacy and safety of resistance training for knee osteoarthritis and subsequent knee replacement: A systematic review and meta-analysis.. Annals of Physical and Rehabilitation Medicine, 2026. DOI: 10.1016/j.rehab.2026.102122.

3. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 randomised trials, assessing pain, physical function and quality of life immediately after treatment and the sustained effect at 2-6 months and beyond 6 months. Only 19 of the included studies (20%) met all three low-risk-of-bias criteria the authors applied.

   Fransen M, McConnell S, Harmer AR, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database of Systematic Reviews, 2015. DOI: 10.1002/14651858.CD004376.pub3.

4. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.